IS THERE A DOCTOR IN THE HOUSE?

August 22, 2006

It's a predicament that's marring retirement for older Americans in pockets dotting the country, particularly temperate, picturesque spots that are a magnet for retirees. Finding and keeping a doctor for some patients is becoming a trial, and health-care executives and patient advocates alike are concerned that the situation will only get worse as the number of retirees grows dramatically in coming years.

Money, of course, is part of the problem.

Some doctors are leaving towns like Santa Cruz, Calif., because of the relatively low payments they get from Medicare, the federal health-insurance program for people 65 and older.

The government reimburses doctors in Santa Cruz County using the same system that's been in place since long before the Northern California real-estate boom.

That means doctors make 15 percent to 20 percent less for seeing Medicare patients there than they do in neighboring Santa Clara County.

But even in places where Medicare pays relatively well, other factors are making it tough for older patients to get face time with doctors:

Demand for medical services is increasing, a reflection of advances in technology used to diagnose and treat medical problems, along with extended life spans and the resulting increase in the number of chronically ill patients.

What's more, doctors are less likely than before to set up their own practices and stay put. Instead, they are forming ever-larger group practices or are going to work for hospital systems that are adding staff -- all to better negotiate with insurers; that mobility can exacerbate local physician shortages.

Meanwhile, among the new wave of retirees are many doctors, who aren't necessarily being replaced in the same places or specialties.

Source: Kelly Greene, "Is There a Doctor in the House?" Wall Street Journal, August 21, 2006.